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MARIUS CALDERON - Global Health Access Gold Lite Plus Worldwide Ex U PDF
MARIUS CALDERON - Global Health Access Gold Lite Plus Worldwide Ex U PDF
Policyowner or Payor:
Marius Calderon
Congratulations on taking a vital step to secure your health with AXA, global leader in insurance. AXA Philippines
is the formidable synergy between two financial giants --- the AXA Group and the Metrobank Group.
Our Global Health Solution is designed to provide you world-class extensive medical coverage for inpatient
treatment, along with benefits such as limited outpatient care, emergency care and medical evacuation. This will
ensure that you can access the best healthcare anytime, here and abroad.
We are delighted to share with you the details of your chosen plan, Global Health Access - Gold Lite Plus. Below
is a summary of your plan and the benefits you can enjoy.
For a yearly maximum benefit of PHP 100,000,000, your Annual Premium will be PHP 129,312.00 . You can pay
semi-annually for only PHP 67,242.24.
The succeeding pages of this proposal provide more details on the benefits and features of Global Health
Access. Benefits may be subject to limits, please refer to your chosen plan’s inclusions/exclusions/limits.
Again, thank you for your interest in Global Health Access. Should you need assistance or clarification, please
call me at the number specified below or call the AXA Customer Care Hotline at Tel. No. +632-8-581-5292.
Premium Breakdown:
The initial Annual premium for the 1st policy year and the estimated Annual premium for the following 2 years are
as follows:
Notes:
1. The first year premium is based on the age nearest birthday of the insureds and hence subject to change
depending on the policy issuance date.
2. Premiums will change according to the attained age on renewal. The premiums shown are those
currently in effect, but the premiums may change upon renewal of the plan and depend on those in
effect at the date of renewal .
If you are not completely satisfied with this Policy, you may return it to our Home Office or any of our branch
offices within fifteen (15) days after receipt of the Policy, together with the membership card(s) and a written
notice requesting cancellation. On such cancellation, you will be entitled to a full refund of the initial premium
paid, provided that no claims have been made.
BENEFITS TABLE
Area of cover Worldwide excluding US
Physiotherapy, Occupational Therapy and Speech Therapy5 , 7 Only as part of ‘Pre- and Post-Hospitalization Outpatient Treatment’
Benefit
Emergency treatment
Emergency Outpatient Treatment due to an accident Included for eligible expenses
Emergency Outpatient Treatment due to non-accident Share the same limit with primary and specialist care, and
diagnostic scan of Outpatient Treatment.
Other benefits Pre-approval is required for cashless transaction of the
following benefits:
Hormone Replacement Therapy7 Only as part of Post-Hospitalization Outpatient Treatment’
Benefit
PHP 20,000
Health screen/Executive Checkup up to Inner limit for reimbursement of Over-the-Counter (OTC)
vitamins is PHP 2,500 per policy year under Health
Screen/Executive Checkup limit
Accidental damage to teeth Included for eligible expenses
Oral and maxillofacial surgery7 Included for eligible expenses
Local road ambulance transport7 Included for eligible expenses
International Emergency Medical Assistance Included for eligible expenses
Pre- and post-natal complications7 (available after 12
consecutive months of membership) Included for eligible expenses
New Born Accommodation 7 Included for eligible expenses
Psychiatric treatment up to7 PHP 400,000 (for In-Patient Treatment only)
Notes:
1) The benefit limits are all in Philippine Pesos. Premium and eligible claims will be paid in Philippine Pesos unless a different
claims reimbursement currency is preferred by you or the insured person at the time of claim. If we could process the eligible
claims in your preferred claims reimbursement currency, please note that you or the insured person would have to bear all
bank/credit charges and foreign exchange losses (if applicable).
2) The benefit limits are per insured person each policy year unless otherwise specified and are reduced each time the insured
person claim only by the net amount (less any deductible or co-insurance) we have actually paid. Please refer to the policy
wording on the full terms and conditions applying to these benefits.
3) Pre-approval is required for cashless transaction before receiving any planned in-patient and Outpatient treatment
recommended by a medical practitioner. Policyholder should contact us before the scheduled treatment to obtain our approval.
By seeking pre-approval, we can confirm the following:
· The planned treatment/s is eligible under the policy
· The planned treatment/s is medically necessary
· The planned treatment/s is within reasonable and customary (R&C) cost
· The planned treatment/s cost falls within the remaining benefit limit of the plan
5) Subject to the limits applicable to the insured person’s plan, we will pay for treatment given by a physiotherapist, occupational
therapist or speech therapist, who is recognized by us and registered to practice where the eligible treatment is given.
Benefit is payable only following in-patient treatment for an eligible medical condition, provided that your insured person has
been covered under the policy since before the in-patient treatment commenced.
Treatment given by physiotherapist, occupational therapist or speech therapist must be under the medical supervision of a
medical practitioner. Medical supervision means that the reason for referral, where applicable, has been initiated by the medical
practitioner who has defined a diagnosis.
There must be a clear treatment plan from the physiotherapist, occupational therapist or speech therapist with an end point and
expected outcome.
6) If the policyholder has opted for annual deductible at the time of application (please refer to the policy specifications), the annual
deductible will apply to all eligible in-patient treatment and any benefit that is arising therefrom, or associated therewith to the in-
patient treatment. Please refer to item 7 for more details.
7) Annual Deductible is applicable to the following eligible in-patient treatment benefits and any benefit that is arising therefrom or
associated therewith to any eligible in-patient treatment:
^If there is no in-patient treatment, the annual deductible will not apply. If there is an eligible in-patient treatment, the annual
deductible will apply to the in-patient treatment and the associated benefits.
Pre-existing condition(s) refers to any medical condition which during the two (2) years preceding the policy effective date, or
reinstatement date, or plan upgrade date, whichever date is later: (i) your insured person has been diagnosed; or, (ii) for which
your insured person has received medication, advice or treatment, or, (iii) which the policyholder and/or your insured person
should reasonably, based on our appointed independent medical practitioner’s opinion, have known about; or, (iv) for which your
insured person has experienced symptoms even if your insured person has not consulted a medical practitioner. There will be a
waiting period of one (1) year for pre-existing conditions.
For avoidance of doubt, if you did have any pre-existing condition(s) before joining, please declare on the relevant Application
form. Such pre-existing condition(s) will also be subject to medical underwriting and if not disclosed they may not be covered
under this policy.
9) Treatment of Pre-Existing Conditions: COVERED FROM DAY 1 IF QUALIFIED TAKEOVER
Takeover is defined by a transfer from a similar plan which the insured has been covered with for at least 365 consecutive days.
The insured’s prior plan should have similar plan limits, benefits and area of cover and the insured should pass AXA Philippines
underwriting qualification.
10) Nontakeover plans will have an applicable waiting period of 12 consecutive months for the following acquired medical conditions
and their associated medical conditions:
1. Cancer 2. Hepatitis B 3. Hepatitis C
4. Diabetes 5. Heart Disease 6. Kidney Failure
7. High Blood Pressure 8. Chronic obstructive pulmonary disease 9. Liver cirrhosis
10. Stroke/Cerebrovascular accident 11. Transient ischaemic attack
11) Premium rates of Global Health Access are not guaranteed. Subject to approval of the Insurance Commission, AXA Philippines
reserves the right to change all or any part of this policy that will be issued including the Benefits Table and/or any of the terms
and conditions.
12) Premium of Global Health Access will be adjusted based on the attained age of the insured on each policy anniversary and
according to the prevailing premium rates at the time of renewal. You may refer to your Financial Executive/Financial Advisor or
AXA for more information on renewal premium.
This proposal is an illustration only of the key features of the recommended insurance plan. You should refer
to your Financial Executive/Financial Advisor or the Company for more information. If your application is
accepted, you will receive a policy contract which will include detailed terms, conditions and exclusions.
Page 6 of 7 Expiry Date: 01/01/2021
Created Date: 11/02/2020 Printed Date: 11/02/2020 Date of Next Insurance Age: Principal Insured: 03/08/2021
Version Number: 4.5.1
Plan Code: GHX5
Global Health Access
for: Marius Calderon, 64
MARIUS CALDERON
Financial Advisor/Financial
Applicant/Policy Owner Date Date
Executive
Signature over Printed Name
Signature over Printed Name
General Disclaimer
All information and opinions provided are of a general nature and for information purposes only. The
information and any opinions herein are based upon sources believed to be reliable, and AXA Philippines, its
officers and directors make no representations or warranty, expressed or implied, with respect to the
correctness, completeness of the information and opinions in this document. Please carefully read the policy
and endorsements and consider the risks, charges and expenses before buying the policy. You should seek
professional advice from your financial, tax, accounting or legal consultant before buying the policy.
THIS FINANCIAL PRODUCT OF AXA PHILIPPINES IS NOT INSURED BY THE PHILIPPINE DEPOSIT
INSURANCE CORPORATION (PDIC) AND IS NOT GUARANTEED BY METROBANK OR PS BANK.